Patients often report what may seem to the health‐care professional to be bizarre or irrational beliefs. However, when we investigate further the background of these beliefs they can often have a simple, if important, route. The above statement, for example, was spoken in clinic by a chronic back pain patient who had been informed that he had marked ‘disc degeneration’ on x‐ray findings. For all patients with pain, what is understood about the meaning of pain, disease and/or disability will play a part in the presentation of the problem and the effectiveness of treatment. For patients with chronic pain, these beliefs form part of the psychosocial context, known to be the largest influence in predicting the extent of pain‐associated disability. For the clinician interested in improving assessment and treatment, an understanding of the role of psychological factors in the presentation of a pain problem is a fundamental requirement.